Guest Blog from Dr. Stefanie Carnes
Over the years I have developed a tremendous amount of respect for Dr. Stefanie Carnes and her work as both a clinician and a trainer of clinicians. Currently, she serves as President of the International Institute for Trauma and Addiction Professionals and as a National Clinical Consultant for Elements Behavioral Health. She is also the author of numerous well-regarded research articles and several books, including Mending a Shattered Heart: A Guide for Partners of Sex Addicts and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts.
Recently, Dr. Carnes wrote the following article addressing the mistaken belief (in certain parts of the psychotherapeutic community) that recovering sex addicts must squeeze themselves into a narrow definition of sexual health if they are to remain sexually sober. This misconception is a prejudice that properly trained sex addiction therapists have battled for decades. In truth, sex addicts can enjoy any sort of sex they’d like, as long as it’s non-compulsive and not creating negative life consequences.
Please read what Dr. Carnes has to say, printed below.
Who Says Recovering Sex Addicts Can’t Have Mind-Blowing Sex?
Stefanie Carnes, PhD, CSAT-S
In recent days, several blogs have been posted with misconceptions about using the sex addiction model to treat compulsively sexual clients. A primary concern seems to be that sex addiction therapists choose to impose their own moral and/or religious values when defining sexual sobriety – attempting to pathologize any nontraditional form of sexual expression, be it kinks, homosexuality, bisexuality, non-monogamy, or anything else. In other words, the perception is that certified sex addition treatment specialists want to put every sex addict into a monogamous, heterosexual, vanilla (missionary position only) relationship.
Nothing could be further from the truth. In fact, sex addiction is defined by the compulsive use of sexual fantasies and behaviors to avoid emotional discomfort; sex addiction is not defined by who or what it is that turns a person on. Quite frankly, many sex addicts new to recovery are worried that they will never be able to have sex again – or at least not hot, super-satisfying sex. As a sex addiction therapist, I make it clear to these clients right from the start that the goal of sex addiction treatment is to stop the compulsive sexual behaviors that are causing problems in the addict’s life – no more, no less. Neither ongoing celibacy nor changing the addict’s arousal template are part of the equation.
Sex addiction therapists are trained to understand and accept that every sex addict is different, entering treatment with a unique family background, trauma history, sexual history, relationship history, and arousal template. Because of this, each client will have a highly personalized definition of sexual sobriety – with the common ultimate goal of a non-compulsive, incredibly satisfying, emotionally and psychologically rewarding sex life. Thus, the definition of sexual sobriety for a heterosexual 35-year-old married father of three will probably differ significantly from the definition of sexual sobriety for an un-partnered openly gay 22-year-old man.
In many ways, modern sex addiction treatment is similar to the treatment of eating disorders – another area in which total abstinence is not a feasible endgame. Essentially, each individual must define what is healthy for him or her, based on his or her life goals and history. Eating (or sex) that is compulsive and consistently leads to negative consequences is avoided, while whatever it is that qualifies as healthy and life-affirming for that particular individual is great.
Usually, recovering sex addicts split their behaviors into three “boundaries” or “circles.” Before creating this boundary/circle plan for sexual sobriety and health, addicts generally create a list of overarching goals – for life, relationships, and sexuality. Boundary/circle plans are then based on those goals.
- The inner boundary/circle defines the problem-causing sexual behaviors that the addict needs to avoid. Neither homosexual activity nor any other nontraditional sexual activity belongs in this boundary, even if that behavior is ego-dystonic (unwanted). That said, for some sex addicts certain very specific compulsive sex acts may fall into this boundary/circle. For instance, one gay sex addict that I treat has “Looking for sex in the steam room at my gym” listed as a bottom line behavior to avoid. But this does not in any way prevent him from enjoying healthy gay sex elsewhere.
- The middle boundary/circle defines “slippery” behaviors that may lead to relapse. These behaviors can be related to sex, such as driving past strip clubs, visiting certain websites, or leafing through a lingerie catalog. They can also be unrelated to sex, such as overworking, not getting enough sleep, and skipping therapy and/or 12-step meetings.
- The outer boundary/circle defines healthy behaviors that promote sexual sobriety, sexual fulfillment, and a happier, healthier, non-addictive life. As with the middle boundary/circle, these behaviors can be related to sex, such having a connected and intimate sex life with a long-term partner, exploring the kinks or fetishes that turn the addict on in a healthy and non-compulsive way, or any other sexual behavior that the addict identifies as a healthy sexual activity. These items can (and should) include some non-sexual goals, such as going back to school, improving one’s career, getting in shape, and the like.
I want to be perfectly clear here: Sexual sobriety should never be defined by who or what it is that turns a person on. If a recovering sex addict wants to put an orientation (as opposed to a specific, compulsive, problem causing behavior) into his or her inner boundary/circle, a properly trained sex addiction treatment specialist will counsel otherwise. Everyone has different things that turn them on, and often these exciting turn-ons can be incorporated into an addict’s plan for healthy sex. As such, recovering sex addicts are not limited to heterosexual “vanilla” interactions. If the missionary position is what turns them on, then sure, they should go for it. If not, they both can and should find ways to incorporate into sexual sobriety the more tantalizing elements of their arousal template.
There are times when behaviors included in an addict’s arousal template are not healthy for them in their recovery. For example, I once treated a physician who was struggling with compulsive masturbation – doing it approximately 10 times per day, usually between office visits with his clients. For him, masturbation, a practice that can often be integrated over time onto someone’s healthy sex plan, is a bottom line activity. In another instance, a client who was using child pornography has needed to always keep that aspect of the arousal template listed as an inner circle behavior.
For most recovering sex addicts, this plan for sexual health is a work in progress that changes over time. Many sex addicts try new things relatively often, finding that they like them and can enjoy them in healthy, non-compulsive, non-problematic ways, or that the new activity is either not much fun or too close to their inner boundary. As an example of a changing plan, consider the 22-year-old openly gay man mentioned earlier. Because he is single when he enters recovery, he may have a goal of finding a long-term partner – which means he needs and likely wants to date and be sexual (in healthy ways) with a variety of men. However, several years later, when he meets the man of his dreams and makes a long-term commitment to that man, his definition of sexual sobriety is likely to change. And there is nothing at all wrong with that.
About homosexuality and nontraditional forms of sexuality in the confines of sex addiction treatment… True sex addiction therapists are trained to never treat homosexuality, bisexuality, transsexuality, or transgender clients as pathological. We DO NOT EVER ATTEMPT CONVERSION THERAPY as part of sex addiction treatment. In reality, there will be misguided therapists who will perform treatment according to their beliefs or values that do not mirror accepted clinical practice – and that can happen in any specialty – but this is specifically outlined in the ethics code of a sex addiction therapist.
Consider the words of my colleague, Rob Weiss, noted sex addiction treatment specialist and author of Cruise Control: Understanding Sex Addiction in Gay Men:
There is no credible evidence that any form of gay conversion therapy works. In fact, sexual orientation is now generally regarded as fixed and immutable. This means that gay men are sexually and romantically attracted to other men, lesbians are sexually and romantically attracted to other women, and bisexuals are sexually and romantically attracted to both genders – and no amount of aversion therapy, talk therapy, social pressure, or prayer is going to change that. … In addition to being a waste of time, energy, and money, conversion therapy may actually be harmful, especially to young people (who are often involuntarily subjected to it). For the most part this damage is caused by gay conversion therapy’s inherent reinforcement of social prejudices against homosexuality. … Recognizing these dangers…virtually every major medical and psychotherapeutic professional organization has issued a statement condemning conversion therapy.
Needless to say, this is the stance that sex addiction therapists are trained to take at all times no matter what. Our goal is never to change a person’s orientation. Rather, it is to help our clients find healthy, non-addictive, non-problematic ways to indulge and enjoy their arousal template. Because of this, recovering sex addicts, whatever it is that turns them on, can always have an incredibly satisfying, flat-out mind-blowing sex life.